经食管实时三维超声心动图定量分析获得性病变二尖瓣的结构

发布时间：2018-09-11 07:00

【摘要】：目的应用经食管实时三维超声心动图及量化分析软件分析风湿心脏病、退行性变及慢性继发性二尖瓣病变致二尖瓣环及瓣叶结构的变化特点。方法本研究共分两部分,分别比较原发性二尖瓣病变与正常对照组,慢性继发性二尖瓣病变与正常对照组。风湿组21例(二尖瓣重度狭窄9例,二尖瓣重度关闭不全6例,二尖瓣重度狭窄伴重度关闭不全6例)、退行性变19例(均为二尖瓣脱垂伴大量返流)、继发于主动脉关闭不全致二尖瓣重度返流组20例与正常对照组20例均行经食管实时三维超声心动图检查,并使用Tom Tec-Arena?1.0-4D MV-Assessment?2.3量化分析软件进行后处理分析。结果第一部分:风湿性二尖瓣病变对二尖瓣瓣环的影响体现在瓣环前后径增大,横径变化不大;退行性二尖瓣病变致瓣环前后径、瓣环横径均扩张明显,瓣环的球形指数(Sphericity index)反而没有增大,而瓣环的周长、面积均增大,瓣环原有的“马鞍形”立体结构趋于平坦。对瓣叶的影响,风湿性病变主要影响二尖瓣前叶,有狭窄病变时前叶面积、长度较正常组明显增大,后叶面积改变则不显著;退行性变使二尖瓣前、后瓣叶面积均显著增大;后叶与瓣环夹角以风湿性二尖瓣狭窄伴关闭不全组增大显著。无论是风湿各组还是退行性病变组,二尖瓣前后径与主动脉瓣环间夹角均显著增大。对二尖瓣动态分析中发现,风湿组二尖瓣瓣环的最大位移、瓣环面积的压缩比较对照组明显减小,而退行性变组则变化不显著。第二部分:左室舒张末期内径组间差异显著,慢性继发性二尖瓣关闭不全(Chronic Secondary Mitral Regurgitation,CSMR)组较对照组明显增大;与正常组相比较,慢性继发性二尖瓣关闭不全组的瓣环前后径、左右纤维三角间径、瓣环周长、瓣环面积均增大,瓣环球形指数及前后瓣环间角度无统计学差异。慢性继发性二尖瓣关闭不全组瓣环高度较正常组小。AHCWR即瓣环高度(Annular Height)与跨前后交界间径(Commissural Width)的比值,通常认为其值减低提示二尖瓣环变平。CSMR组AHCWR值较正常组减小。对瓣叶的分析,前叶面积及前叶瓣环至闭合缘的长度较对照组均无统计学差异,而后叶面积及后叶瓣环至闭合缘的长度较对照组增大。两组间后叶与瓣环夹角、二尖瓣前叶对合缘长度、二尖瓣后叶对合缘长度均无明显差异。CSMR组二尖瓣前后径与主动脉瓣环间夹角较对照组增大。对瓣环的动态分析发现,CSMR组二尖瓣环最大位移、瓣环面积的压缩比均较对照组减小。结论1.风湿性二尖瓣病变主要侵害瓣叶及瓣下结构,对瓣环的影响相对较小,但瓣叶的病变明显限制了瓣环的运动;2.退行性病变时瓣环明显扩张、扁平,但仍保留“马鞍形结构;3.主动脉瓣关闭不全继发性二尖瓣关闭不全时,伴随左心室的增大二尖瓣环扩张、变平,二尖瓣瓣叶闭合障碍。
[Abstract]:Objective to analyze the characteristics of mitral annulus and lobes in patients with rheumatic heart disease, degenerative disease and chronic secondary mitral valve disease by transesophageal real-time three-dimensional echocardiography and quantitative analysis software. Methods the study was divided into two parts: primary mitral valve disease and normal control group, chronic secondary mitral valve disease and normal control group. In rheumatic group, 21 cases (9 cases of severe mitral stenosis, 6 cases of severe mitral insufficiency), There were 6 cases of severe mitral stenosis with severe regurgitation), 19 cases of degenerative mitral valve prolapse with massive regurgitation, 20 cases of severe mitral regurgitation caused by aortic insufficiency and 20 cases of normal control group. Tube real-time three-dimensional echocardiography, And use Tom Tec-Arena?1.0-4D MV-Assessment?2.3 quantitative analysis software for post-processing analysis. Results in the first part, the effect of rheumatic mitral valve disease on mitral annulus was reflected in the enlargement of the anterior and posterior diameter of mitral annulus, the little change in the transverse diameter of mitral annulus, and the obvious dilatation of the anterior and posterior diameter of the annular and the transverse diameter of the annulus caused by degenerative mitral valve disease. However, the spherical index (Sphericity index) of the annulus does not increase, but the circumference and area of the annulus increase, and the original "saddle shape" structure of the annulus tends to be flat. The anterior lobe area of mitral valve was mainly affected by rheumatic lesion, the length of anterior lobe was significantly larger than that of normal group, but the change of posterior lobe area was not significant, degenerative mitral valve and posterior lobe area were significantly increased. The angle between posterior lobe and annulus was significantly increased in rheumatic mitral stenosis with insufficiency. In both rheumatic and degenerative groups, the anterior and posterior diameter of mitral valve and the angle between aortic annulus were significantly increased. In the dynamic analysis of mitral valve, it was found that the maximum displacement of mitral annulus and the compression of annular area in rheumatic group were significantly smaller than those in control group, but there was no significant change in degenerative group. Part two: the difference of left ventricular end-diastolic diameter between groups was significant, and that of chronic secondary mitral insufficiency (Chronic Secondary Mitral Regurgitation,CSMR) group was significantly larger than that of control group, and the anterior and posterior annular diameter of chronic secondary mitral insufficiency group was significantly higher than that of normal group. The diameter of the left and right fibers, the circumference of the annulus and the area of the annulus increased, but there was no significant difference in the global index of the valve and the angle between the anterior and posterior annulus. The value of AHCWR in the patients with chronic mitral insufficiency was smaller than that in the normal group. The ratio of annular height (Annular Height) to the cross anterior and posterior interfacial diameter (Commissural Width) was generally considered as indicating that the AHCWR value in the mitral annular flattening group was lower than that in the normal group. There was no significant difference in the area of the anterior lobe and the length from the annulus to the closing edge of the anterior lobe compared with the control group, but the area of the posterior lobe and the length of the annulus from the posterior lobe to the closing edge of the control group were larger than that of the control group. There was no significant difference in the angle between posterior lobe and annulus, the length of anterior mitral valve involute edge and the length of posterior mitral valve involute edge. The anterior and posterior diameter of mitral valve and the angle between aortic annulus in CSMR group were larger than those in control group. The results of dynamic analysis of mitral annulus showed that the maximum displacement of mitral annulus and the compression ratio of annular area in CSMR group were lower than those in control group. Conclusion 1. Rheumatic mitral valve lesion mainly invades the lobes and subvalvular structures, and has relatively little effect on the annulus, but the lesion of the valvular lobe obviously limits the movement of the annulus. In degenerative lesions, the annulus is obviously dilated and flat, but the saddle structure remains. Aortic insufficiency secondary mitral insufficiency accompanied by left ventricular enlargement mitral annulus dilatation flattening mitral valve lobe closure disorder.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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